Lifeline Central West chief executive Stephanie Robinson said it was vitally important that we start changing the way we speak about mental health.

"Mental ill health can arise due to many different factors including social and environmental circumstances that impact our lives," said Ms Robinson.

"Suicide is a difficult topic to talk about, however it does not make sense not to talk about it and build awareness when it is the biggest killer of people 15 to 44 years of age.

"Self harm, anxiety and depression are all connected to how we are feeling. We know suicide can and often is preventable with the right support however due to its nature, people suffering can get good at masking the signs.

Ms Robinson said that by having conversations, building awareness and equipping both adults and young people with the knowledge to recognise, respond and refer, we can create safer communities for us all.

"If you see someone struggling with their mental health, genuine conversations without distraction are a good first step."

She said don't be afraid to say 'I don't know the answers, but let's find out together' and ask the person "how would you like me to help you?"

"At Lifeline we have a phone, text and chat service that can be used and do not be offended if the young person prefers to talk to a friend or other support instead of you," she said.

"Just encourage them to connect with help."

Importantly, if you notice what they are saying and their actions do not align, reflect to them what you are seeing.

"For example 'I know you just said there is nothing wrong, however I have noticed you are not eating dinner, your light is on late at night and I'm worried you haven't seen your friends for a few weekends in a row now. Could you let me know what's causing you to feel so down, I'm worried?"

"If you have seen big changes in behaviour - for example withdrawing, risk taking, avoidance etcetera - you may need to ask directly about suicide.

"We know it does not put the idea in someone's head and is rare when asked with care and concern, to cause offence."

Ms Robinson said there were signs people could look for, which could indicate someone was struggling.

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"Changes in behaviour. It is not always a decline, sometimes if people have made up their mind they may come across as settled and calm."

Also look for any evidence of self-harming behaviours; substance misuse, cutting, burning etcetera - often in places that are hard to see.

"Other signs are withdrawing from activities, becoming careless or caring less about things that usually matter or changes in sleeping pattern.

Ms Robinson said, most importantly, people needed to know help was out there.

"Don't do it alone. It is an isolating experience to feel depressed and anxious.

"Connect online to headspace, Reachout or Lifeline. Lifeline is there 24/7 and is free and confidential. There is also a Kids Helpline.

"Tell someone if you are feeling so low that you are thinking of self harm or suicide. You are not alone."

She said it was vital as a community to talk about the tragedy of suicide.

"We often expect and encourage people who are struggling to reach out, which is a big ask when incredible pain is being experienced.

"We also have to take personal responsibility to be kind to one another."

Ms Robinson said the time has come to have the hard conversations.

"I think it's important that Tilly's death highlights that this is real. Hard conversations need to be embraced and not avoided. People need to be held accountable for any bullying behaviours that they witness.

"Involve kids in the conversation, ask them what they think, empower them. Set a culture that reports any bullying particularly image based abuse and cyber bullying so that it is not tolerated and reporting is expected.

She also said after a death like Tilly's there can be a need for youth to come together and grieve.

"They may feel survivor guilt or be suffering from guilt they witnessed and didn't act on seeing bullying.

"Bystander effect is real and can cause harm if not addressed. Hindsight and reflecting on what we could or would have done can be damaging.

"Instead we look at ways to change the cultures and make changes. We know bullying leads to far greater levels of depression, anxiety, stress and lowered self esteem."

If not dealt with, she said the impacts can be devastating.

With the eSafety Commission reporting one in five children are bullied online, the community is reminded that reports of cyber bullying and image-based abuse can be lodged with and investigated by the eSafety Commissioner.

eSafety Commissioner Julie Inman Grant said eSafety treats all reports of online abuse seriously. To report online bullying,or find out how eSafety can help, go to www.esafety.gov.au

If you need support please contact:

Lifeline 13 11 14

Beyond Blue 1300 224 636

Kids Helpline 1800 55 1800

eSafety.gov.au

headspace.org.au

au.reachout.com

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